The Articular Surface Replacement (ASR) hip system displayed unexpectedly high failure rates. All patients who underwent revision arthroplasty at our institution were identified. Indications for revision were classified as objectively identifiable or performed for unexplained pain. Clinical outcomes, post ASR revision, were superior in cases where the aetiology for failure was identifiable. Pain and function improved reliably when a targeted objective indication was identified pre-revision, but failed to do so in cases of unexplained pain. Surgeons familiar with the results of this study will be empowered to discuss expectations and realistic outcomes with their patients undergoing complex revision arthroplasty cases. © 2020 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.Aims We report our early experience in acetabular reconstruction for significant bone loss and pelvic discontinuity using custom triflange acetabular components. Patients and methods Retrospective consecutive review of all patients treated at our specialist tertiary unit with significant acetabular defects (Paprosky 3A/3B) and pelvic discontinuity who were reconstructed with custom triflange implants. The primary outcomes were radiographic failure and complications. Results 17 patients (17 hips) were included; 3 males/14 females with a mean age of 72 years (range 61-83). The average follow-up was 3.6 years (2-7 years). Bony defects were Paprosky 3B in 13/17 hips (76%) with pelvic discontinuity encountered in the majority of cases 15/17 hips (88%) and intra-pelvic failed components in 11/17 (64%). At final follow up, no radiographic failures were observed although three patients developed complications (17.6%); haematoma requiring washout out; intra-operative ilium fracture; and recurrent dislocation in one patient. Conclusions Our experience suggest that acceptable outcomes can be achieved with custom implants for this group of challenging patients, although longer follow up is needed to monitor future implants' failure. Crown Hip joint subluxation and dislocations are very common in cerebral palsy (CP) patients and are directly related to a patient's degree of spasticity. Hip dislocation and subluxation leads to hip pain and difficulty in hygiene maintenance by a caregiver. Most cases require surgical intervention to improve the quality of life in these patients. For many years pelvic and proximal femoral osteotomies with soft tissue releases were the mainstay of treatment for affected hips in CP patients. Recently, hip arthroplasty has been proposed as a very successful operation which provides a pain free and mobile joint in CP patients. The purpose of this review is to evaluate the current evidence for effectiveness of total hip arthroplasty in CP patients. © 2020 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.Purpose to evaluate our consecutive series of tubeplasty and extensor mechanism reconstruction during knee arthroplasty in patients with previous patellectomy. Methods we describe our surgical technique and present a retrospective consecutive series of 4 patients with a minimum 6 months follow-up. Knee society score (KSS), clinical and radiographic outcomes were collected at final follow up. Results we included 4 patients (2 males/2 females) with average age 65.5 years (range 58-76). There were 2 primary and 2 revision knee arthroplasties. The follow up ranged from 0.5 to 13 years. All 4 patients regained function and satisfactory clinical outcomes with KSS score 84.7 (range 79-90). Conclusion satisfactory clinical outcomes can be achieved with extensor mechanism reconstruction and tubeplasty in patients with previous patellectomy undergoing primary and revision knee arthroplasty. #link# Level of evidence IV. Crown Introduction Since less invasive approaches for total hip arthroplasty (THA) are promoted, our aim was to compare direct lateral (DLA) and anterolateral approach (ALA) under otherwise identical conditions. Methods Pre - and postoperative x-rays from 200 propensity matched patients (DLA vs. ALA) were evaluated for anatomical reconstruction. Results Overall, the cup position was within the safe zone in both group while the mean center of rotation (COR) was placed more medial and cranial in both groups compared to preoperative anatomy (p &gt; 0.05). The mean leg elongation was comparable between both approaches (p &gt; 0.05). Postoperatively the WOMAC improved about 90%. Conclusion This study confirmed that the ALA can be safely used for THA in minimal invasive setting. © 2020 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.Acute traumatic posterior glenohumeral dislocation in association with a massive rotator cuff tear is rare. Moreover, only few cases with interposition of the long biceps head of the tendon has been described to prevent reduction in posterior dislocation of the shoulder. In addition, combined scapula fracture with posterior shoulder dislocation also extremely rare. We present a case of Irreducible posterior fracture and dislocation of shoulder with massive rotator cuff tear due to incarceration of biceps tendon. For the treatment arthroscopic in situ superior capsule reconstruction was performed using the long head of the biceps tendon with rotator cuff repair. © 2020 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.Background Dislocation is a major cause of morbidity and revision surgery following total hip arthroplasty (THA). To address such issues, dual mobility (DM) bearings were introduced as a more stable alternative to fixed-bearing (FB) prostheses. As such, we compared DM and FB systems in a cohort study in terms of dislocations, readmissions, and revisions. Methods A 27 multi-center retrospective review was performed of 664 DM and 218 FB cases from the same manufacturer with mean follow-up of 2.09 years and 1.83 years, respectively. Patient reported outcome measures (PROMs) including Harris Hip Score (HHS), SF12, EQ5D, and Lower Extremity Activity Score (LEAS) were evaluated as well as dislocation rates, readmissions, and revisions rates. https://www.selleckchem.com/products/withaferin-a.html performed a survivorship analysis through Kaplan-Meier estimator. Students t-test was used for normally distributed continuous data and Fisher exact test (P&nbsp; less then &nbsp;0.05) was used for discrete data. Results There were 0 dislocations in the DM (0%) group and 2 dislocations in the FB (0.